The Tinnitus Specialist Blog
Thoughts and inspiration from a Harley Street tinnitus specialist.
New Tinnitus Treatments 2014
What effective new tinnitus treatments are there in 2014?
Prospective patients and sometimes their loved ones often ask me if there have been any effective new tinnitus treatments discovered in 2013, or even if there is a cure for tinnitus yet.
I have to say that 2013 has been a good year for new developments in tinnitus treatment. We have some good evidence on the effectiveness of existing treatments, and some very exciiting new developments that have emerged out of research within the last few years from the University of California.
So what do we know about tinnitus treatment?
Known risk factors for tinnitus include: middle ear infection, inner ear infection, infection of the mastoid bone, tumour of the balance nerve, tumour of the brain lining, sensorineural hearing loss, Ménière's disease, vertigo of the inner ear, impacted earwax, otosclerosis, age related hearing loss, noise exposure, meningitis, migraine, multiple sclerosis, epilepsy, head or neck injury, loss of consciousness, TMJ disorder, high blood pressure, rheumatoid arthritis, lupus, systemic sclerosis, diabetes, hypothyroidism, hormonal changes due to pregnancy, anxiety, depression, emotional trauma, pain killers, antibiotics, chemotherapy drugs, corticosteroids, diuretics, immunosuppressants, NSAIDs, and steroidal anti-inflammatory drugs.
Having one of the above risk factors doesn't mean that you will definitely get tinnitus, but it does increase the likelihood of getting it.
Existing tinnitus treatments - the evidence
Somewhat surprising is that a systematic review found that the evidence for the use of sound therapy, for example music or white noise generators, in treating tinnitus is inconclusive. That doesn't mean that it doesn't work. It could be that it works for some people, but it doesn't necessarily work for others.
Many audiologists, myself included, find that where there is also a hearing loss, hearing aids, for example the Siemens Micon, Phonak Audéo Q, Starkey Xino Tinnitus or Unitron Moxi Kiss, can be effective at reducing tinnitus. Many of my patients have spontaneously told me that their tinnitus has gone, or has dramatically reduced, when I have fitted them with correctly prescribed hearing aids. When the tinnitus doesn't go completely, the aforementioned hearing aids have built in white noise generators that can produce a soothing sound that can help the tinnitus blend away.
There is good evidence that relaxation, Hypnotherapy and Cognitive Behavioural Therapy are all helpful in reducing tinnitus distress. Tinnitus Retraining Therapy (TRT), a combination of directive counselling, in other words explanation, and the use of white noise generators, has been shown to be more effective than using white noise generators alone.
Sady, there is a lot of politics in the world of tinnitus treatment and tinnitus research. You could probably say that about medical research in general where, for example, one charity or funding body will not endorse research that was funded by another source as that would somehow be admitting defeat.
As discussed above, direct electrical stimulation using electrodes has reduced tinnitus for some patients who are being treated for Parkinson's. This is, however, an extremely invasive treatment as it involves removal of a portion of the skull to implant electrodes into the brain.
A non-invasive method of brain stimulation uses repetitive exposure of the brain to strong magnetic fields, but this has a short-term effect. It does have some supporting evidence, and there have been no serious side effects reported, although the long-term consequences of this treatment are unknown.
Emerging tinnitus treatments: Neuromonics, ANM, SoundCure Serenade® - the evidence
There are several emerging tinnitus treatments, including Neuromonics (a sound therapy using music where the tinnitus pitch has been removed), Acoustic Coordinated Reset Neuromodulation (ANM, a therapy that is based on a Parkison's syndrome treatment using electrodes implanted in the brain), and SoundCure Serenade®. Neuromonics sounds like a good idea, but according the the Lancet paper, doesn't have any proven benefit for tinnitus symptom reduction. Some patients with tinnitus undergoing deep brain stimulation for Parkinson's reported that their tinnitus became quieter - however, there doesn't seem to be any proven benefit of the ANM tinnitus treatment, which uses sound delivered via headphones, according to the Lancet article.
SoundCure Serenade®, on the other hand, is based on research that has come out of the University of California, Irvine. The first research on S-Tones® was published in 2010 and was based a kind of sound stimulus that was originally used as a tinnitus treatment for patients who had been fitted with a cochlear implant. The first patient to experience tinnitus relief using the stimulation pattern used in the Serenade® had completely lost his hearing overnight, and had catastrophic tinnitus that affected his ability to sleep or even carry out his profession as a sound recording engineer. The fitting of a cochlear implant is often considered in these circumstances, as there is a high likelihood of reduction of tinnitus symptoms, although there is a chance that tinnitus could be worsened. In this case, a cochlear implant was fitted, but it didn not restore the ability to hear speech or music, so the implant team tried to use other kinds of stimulation to mask the tinnitus. After trying what are now known as S-Tones®, the patient commented that his tinnitus had gone for the first time since it had started so catastrophically overnight. Research was published in 2010, 2011 and 2012, covering both the suppression of tinnitus using electrical stimulation via a cochlear implant for those fitted with a cochlear implant, and the suppression of tinnitus using sound delivered via headphones for those who still have usable hearing. The research covering the use of S-Tones® is quite compelling - current statistics show that even with a short treatment of just 3 minutes, around 35% of patients will enjoy more than 70% suppression of their tinnitus, some of those getting complete suppression. Another 35% of patients will experience between 30% and 50% suppression, while the remaining 30% will achieve less than 30% suppression - of course, with a longer treatment, they may get better results. The Serenade® is the size of a mobile phone and can be used at home or while on the move. Experience with Serenade® indicates that many patients find that with repeated use their tinnitus in between treatments is greatly reduced. Some find that after months of use they only need to use the device once a week. It's not exactly a cure, but it's pretty close, and I believe that something that can provide relief for a week at a time is worth a try.
SoundCure Serenade® was fully launched in the UK in 2013, and has been growing in popularity due to its evidence base, its high success rate, as well as it being roughly half the price of the Acoustic Coordinated Reset Neuromodulation treatment.
New drug treatments for tinnitus
There are no medicines licenced in Europe or North America for the treatment of tinnitus. The only drugs which have been consistently effective are the local anaesthetics when injected intravenously, but they have the side effect of heart arrythmia, i.e. they could kill you. This has been known since 1935, and since then there has been an effort to develop safer versions without side-effects, but so far there has been no breakthrough.
Two announcements in 2013 are mildly encouraging, as drugs that prevent the onset of tinnitus by targeting potassium channels within the brainstem are being developed and trialled, but there are side effects. Unfortunately, they won't cure tinnitus that is already established as a different area of the brain is involved by this stage. I have covered these announcements elsewhere in my blog.
Melatonin has been used in several trials, and it may alleviate insomnia in tinnitus patients.
Laser treatment for tinnitus
There are some manufacturers producing low intensity laser devices for the treatment of tinnitus, though there is no convincing explanation of how they are supposed to reduce tinnitus. Most studies suggest that lasers are ineffective at reducing tinnitus, though I can understand why some tinnitus sufferers might buy one of these laser devices for a few hundred pounds on the offchance that it might work. I mean, they're lasers, and the manufacturer says that they help the hair cells regrow, so they've got to work, right? Well, no. It seems that they don't. Simply put, they are just a laser pointer with a flexible fiber optic cable attached to one end, and there's no way that they can deliver a significant amount of energy to the target area through the eardrum, and even if they did, it won't help the hair cells regrow. Sorry.
Surgery for tinnitus
Cochlear implantation for patients with profound hearing loss and tinnitus is successful at reducing or eliminating tinnitus in the majority of cases. There is also a role for surgery in some cases of pulsatile tinnitus, however some cases of pulsatile tinnitus are inoperable, and in some cases the cause cannot be found. If you think you might qualify as a candidate, then it is best to seek advice from an ENT Consultant in the first instance.
Just want more information or ready to take the next step?
If you've read this far, then the likelihood is that you'd like to either discuss one or more of the treatments above or you want to book an appointment to try out the Siemens Micon, Phonak Audéo Q, Unitron Moxi Kiss, Starkey Xino Tinnitus, or the SoundCure Serenade®. Please call me on 020 3397 9787 and I'll be glad to talk things over with you. I welcome clients from all over the UK, and see clients from around the world as they are passing through London.
Acknowledgements: Thanks to Dr David Baguley PhD, Mr Don McFerran FRCS and Professor Debra Hall PhD for publishing the article "Tinnitus" in the July 2013 edition of The Lancet, upon which some of this blog article is based.